Tuberculosis in Malaysia: A Continuing Surge

Roy Rillera Marzo

Department of Global Health and Community Medicine, Asia Metropolitan University, Malaysia

*Correspondence to: Dr. Roy Rillera Marzo, Department of Global Health and Community Medicine, Asia Metropolitan University, Malaysia.

Copyright © 2018 Dr. Roy Rillera Marzo. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Learning Objectives
At the completion of this WebQuest learning module, students should be able to:

1. Evaluate the epidemiology of tuberculosis in Malaysia.
2. Create a health promotion strategy for tuberculosis in Malaysia.
3. Formulate a medical care plan posters and health teaching plan for tuberculosis.

Introduction
Tuberculosis (TB) is an airborne disease caused by the bacterium Mycobacterium tuberculosis. A chronic bacterial infection caused by Mycobacterium tuberculosis characterized pathologically by the formation of granulomas. The most common site of infection is the lung, but other organs may be involved in brain, kidneys, liver, and spleen.

Tuberculosis (TB) is one of the world’s most important infectious causes of morbidity and mortality among adults. In 2015, the World Health Organization reported that there were an estimated 10.4 million new TB cases worldwide, of which 5.9 million (56%) were among men, 3.5 million (34%) among women and 1.0 million (10%) among children. About one-third of the world’s population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with the disease and cannot transmit the disease. These people with latent TB can get active TB disease if their immune system is low or if they are taking any treatment that can suppress their immune system.

Malaysia is classified as a country with an intermediate TB burden, that is, notification rate for TB of 81 cases per 100,000 populations in 2016. A number of TB cases notified in 2016 are around 24,000. Three states with high TB cases are Sabah, Selangor, and Sarawak, making up a total of almost 50% of all new cases in Malaysia. In 2016 there were 1,696 TB deaths reported (excluding TB/HIV mortality), giving rise to 5.56 TB deaths per 100,000 populations. This TB death rate is the highest among all infectious diseases, including dengue, HIV, and malaria. The age groups commonly affected are above 35 years (62%) and it is always high in the elderly with other co-morbid diseases like diabetes, smoking and kidney diseases (Iyawoo, 2014).

TB is a treatable and curable disease. The vast majority of TB cases can be cured when medicines are provided and taken properly. Thus early detection and effective treatment can prevent TB deaths in Malaysia and all over the world.

Global Impact of TB
TB occurs in every part of the world. In 2016, the largest number of new TB cases occurred in Asia, with 45% of new cases, followed by Africa, with 25% of new cases.

In 2016, 87% of new TB cases occurred in the 30 high TB burden countries. Seven countries accounted for 64% of the new TB cases: India, Indonesia, China, Philippines, Pakistan, Nigeria, and South Africa. Global progress depends on advances in TB prevention and care in these countries (WHO, 2016).

The big questions are why is there a continuous rise in the number of incidences (new cases) of tuberculosis from then to now? What health promotion strategies, if any, have been taken to lower the number of tuberculosis? What are the indicating factors for the increase in the number of tuberculosis incidences by geographic location, economic status, or racial ethnicity? What are best medical care plan and health teaching plan for tuberculosis? The answers to these questions and more will be answered as you work your way through this activity.

The Director-General of Ministry of Health is looking for quick answers the alarming positive trend of tuberculosis in Sabah, Malaysia, and thousands of citizens are counting on you to halt the progress of this disease in your area. You are the public health specialist in that state that has a high incidence and prevalence of Tuberculosis. First, you need to present an evidence-based status of tuberculosis in Malaysia. Second, you suggest different types of health promotion to combat the increasing number of tuberculosis. Third, you should create a medical care plan for those patients with tuberculosis.

Task Description

Prepare to research, study and analyze information gathered.

Task 1: Present a powerpoint interactive presentation from a graphic organizer regarding the extent of morbidity and mortality of tuberculosis in Malaysia.

Task 2: Create a 5-7 minutes public service radio message (audio podcast) or 5-7 minutes public service television message (video podcast) that encourages Malaysian citizen to live a healthy lifestyle to prevent tuberculosis and help to lower the rise in tuberculosis.

Task 3: Formulate a medical care plan poster for the community that has high incidence and prevalence of tuberculosis with the use of Canva: Infographics.

Process

First Session: Total Duration - 4 Hours

Part 1: Epidemiology of Tuberculosis in Malaysia
You must watch the video entitled: Tuberculosis is the leading infectious killer – Ministers declare commitment to end Tuberculosis. (World Health Organization, July 13, 2017). This is will give you an idea why Tuberculosis is considered as Pandemic Disease.

After you watch the video, you will be working together in medium-sized groups with 6 members. Within the group, you will be subdivided into 3 teams (Team A, Team B, and Team C). Twoteams will work on the research and one team will be responsible for the compilation of the research and creation of a power point presentation.

Team A: You will research the incidence and prevalence of tuberculosis in Malaysia. You need to research if there is downward and/or upward trend of tuberculosis for the past 10 years.

Team B: You will research the risk factors of the upward and/or downward trend of tuberculosis in Malaysia.

***Note: Each group 1& 2 will create 5 slides, a summary, about their subject matter.

Team C: As cooperative learning team, you will compile the information and slides into a format to present to the general public (assume the general public is your classmates). You need to assign who will be a recorder and a presenter in order to expedite the process. As a public health specialist, you must learn to create an effective powerpoint presentation using a graphic organizer that is dynamic, informative and visually appealing.

Once the power point presentation is done, brainstorm as a group. You need to review and evaluate the power point slides for content, visual appeal, and creativity before presenting your output to the public. You are given to present your data for 15 minutes and 5 minutes question and answer from the facilitator and the audience. You will be assessed in this presentation with the use Oral Presentation Rubric.

After the presentation, please fill up the self-assessment and peer assessment forms. The purpose of these tools is to encourage reflection and collaboration among you as a group. As your facilitator, this tool is very important for me to have a clearer or in-depth perspective on the strengths and weaknesses of your learning experience and to hone in on the problem areas you have identified. Immediate feedback on your presentation will be given.

Second Session: Total Duration - 4 Hours

Part 2: Public Service Radio/Television Message

Part 3: Medical Care Plan Posters for Tuberculosis in the Community
First, you will receive feedback from your facilitator based on the previous self-assessment and peer assessment. This feedback is a form of formative and summative assessment.

After the facilitator gives you feedback, you will watch a sample Audio podcast at Centers for Disease Control and Prevention regarding Dengue Virus and Video podcast at University of Oxford regarding Dengue Infection. This related to your Part 2 activity. Check out the selected infographics such Dengue and Malaria Prevention. This related to your activity in Part3.

After viewing the samples of podcast and infographic posters, you will be working together in mediumsized groups with 6 members. Within the group, you will be subdivided into 2 teams (Team A and Team B).

Team A: You will create a 5-7 minutes public service radio message (audio podcast) or 5-7 minutes public service television message (video podcast) that encourages Malaysian citizen to live a healthy lifestyle to prevent tuberculosis and help to lower the incidence and prevalence of tuberculosis. You can use the two most popular sites for creating podcasts which are Audacity (for PCs) and Garageband (for Macs and mobile devices). Please check the list of web resources provided to guide you in this activity.

Team B: You will formulate a medical care poster for the community that has high incidence and prevalence of tuberculosis. You can use Canva to make an amazing graphic design for your poster. Please check the list of web resources provided to guide you in this activity.

Once the podcast and poster are done, all of you must gather and build a consensus review and evaluate the Podcast and Canva before presenting your output to the public. Consensus decision- making must be observed. You are given to present your final output for 15 minutes (5-7 minutes for the podcast and 5-7 minutes poster presentation) and 5 minutes question and answer from the facilitator and the audience. You will be assessed with the use of Podcast Presentation Rubric and Poster Presentation Rubric.

After the presentation, please fill up the self-assessment and peer assessment forms. The purpose of these tools is to encourage reflection and collaboration among you as a group. As your facilitator, this tool is very important for me to have a clearer or in-depth perspective on the strengths and weaknesses of your learning experience and to hone in on the problem areas you have identified. Immediate feedback on your presentation will be given.

List of Web Resources and Learner Scaffolds

Part 1: Incidence and Prevalence of Tuberculosis in Malaysia

Centers for Disease Control and Prevention (2005). Basic Epidemiology for Tuberculosis Program Staff. New Jersey Medical School. Global Tuberculosis Institute. 2^nd edition.

Dony, J. F., Ahmad, J. & Tiong, Y. K. (2004). Epidemiology of tuberculosis and leprosy, Sabah, Malaysia. Tuberculosis, 84(1-2), 8-18.

Dye, C. (2005). Evolution of Tuberculosis Control and Prospects for Reducing Tuberculosis Incidence, Prevalence, and Deaths Globally. Jama, 293(22), 2767.

Practice Guidelines for the Control and Management of Tuberculosis. (2002). Ministry of Health, Malaysia. 2^nd edition.

Malaysia: Incidence of tuberculosis.

Trends in Tuberculosis Morbidity and Mortality. (n.d.). 2018.

Tuberculosis country profiles (2017).

World Health Organization (WHO). (2015). Global health observatory data repository: Tuberculosis, incidence and case detection.

World Health Organization, Global Tuberculosis Report. (2016).

Risk Factors of the Upward and/or Downward Trend of Tuberculosis in Malaysia

Darbyshire, J. H. (1995). Tuberculosis: old reasons for a new increase? BMJ., 310(6985), 954-955.

Ghani, F. A. (2010). Prevalence and associated factors of latent tuberculosis infection among healthcare workers in aninstitute of respiratory medicine Kuala Lumpur.

Iyawoo, K. (2004). Tuberculosis in Malaysia: problems and the prospect of treatment and control. Tuberculosis, 84(1-2), 4-7.

Mohktar, K. S. & Rahman, N. H. (2015). Urbanisation process and the prevalence of tuberculosis in Malaysia. Malaysian Journal of Society and Space, 11(3), 123-127.

Sanusi, S. B. (2015). Epidemiological and awareness study of tuberculosis in BatuPahat, Johor, Malaysia. BatuPahat: Universiti Tun Hussein Onn Malaysia.

Tuberculosis in Malaysia: Combating the old Nemesis. (n.d.). 2018.

Zaman, K. (2010). Tuberculosis: A Global Health Problem. Journal of Health Population and Nutrition.

Part 2: Audio/Video Podcast

What is Podcast?
http://www.howtopodcasttutorial.com/what-is-a-podcast.htm
https://www.thepodcasthost.com/listeners-guide/what-is-a-podcast/

What is a Podcast? A Simple Explanation of Podcasting
https://www.youtube.com/watch?v=_awu2loGzL0

How to Start a Podcast: A Tutorial
https://www.youtube.com/watch?v=xu2QNUY5iyk&list=PLzJ1r4EGn-enCMU1kPstXd7e1SjI3jP_O

How to start a Podcast and get your Podcast on iTunes.
https://www.youtube.com/watch?v=4RzcDqwSO3c

Part 3: Canva Poster

How to design your own stunning poster with Canva’s Poster Maker
https://www.canva.com/create/posters/

How to create posters using Canva
https://www.youtube.com/watch?v=92IO9p3kHRA

How to use Canva for Beginners: Fast and easy Tutorial
https://www.youtube.com/watch?v=lokz7kn5LJQ

Evaluation Plan

Self-Assessment Rubric

Name of Student: ______________________ Matric Number: ____________

Reference: University of Wisconsin Rubric (Updated February 21, 2017). Available at: https://www2.uwstout.edu/ content/profdev/rubrics/secondaryteamworkrubric.html

Peer Assessment Collaboration Rubric

Name of Student: ______________________ Matric Number: ____________

Reference: Information Technology Evaluation Services, NC Department of Public Instruction Available at: https://projects. ncsu.edu/midlink/rub.pres.html

Podcast Presentation Rubric

Name of Student: ______________________ Matric Number: ____________

Reference: University of Wisconsin Rubric(Updated November 16, 2015). Available at: https://www2.uwstout.edu/content/profdev/ rubrics/podcastrubric.html

Poster Presentation Rubric

Name of Student: ______________________ Matric Number: ____________

Reference: Rubric developed with materials from the Rubi Star Website: http://www.readwritethink.org/files/resources/lesson_images/ lesson1076/rubric.pdf

Webquest activity is part of your Continuous Assessment. Total marks will be converted to 15% of your final grade. The breakdown of assessment as follows:

Peer Assessment : 10%
Self Assessment : 5%
Oral Presentation : 25%
Podcast Presentation : 30%
Poster Presentation : 30%

Conclusion
Now that you have completed the task you have now a better understanding of theepidemiology of tuberculosis andthe extent of morbidity and mortality of tuberculosis in Malaysia. You are also able to identify the risk factors of the upward trend of incidence and prevalence of tuberculosis in Malaysia. In this activity, you will be able to help people in your community on how to prevent tuberculosis and formulate a medical care plan caused by Mycobacterium tuberculosis.For abetter understanding of the disease, please visit the Ministry of Health, Malaysia, Centers for Disease Control and Prevention (CDC) and World Health Organization websites.

Note: Next page is my reflection on my experience of designing a WebQuest.

Reflection
A WebQuest is student-centered and inquiry-oriented activity in which some or all of the information that learners interact with comes from resources on the Internet [1]. A WebQuest is constructed and presented in six parts called building blocks: introduction, task, process, resources, evaluation, and conclusion.

Designing a WebQuest has been an enlightening experience. Since I do not have a strong background in technology and have very little formal training I am a little bit afraid on working this assignment, however, with the proper instruction provided by our facilitator and research reading about this activity, I able to design my WebQuest activity appealing.

I recognize that WebQuest can assist me as a teacher to see how my students gather and analyze information provided and produce a new knowledge product out of their analysis. I personally like Webquest because of the use of scaffolding. I included questions for each team to guide their thinking in the right direction, along with the use of links that will directly assist them with the questions they have to answer. I also inserted video to remind them of the important events that may help them with their questions. In this way, students are being guided through the WebQuest process and given enough resources to attend to all types of students’ needs for this module. Indeed, WebQuest customizes and personalizes learning activities to address students’ diverse learning styles, working strategies, and abilities using digital tools and resources [2].

From this experience, I learned a lot about technology integration as a teacher, and how you would incorporate it into your teaching instruction. Many times when I think about technology integration, I only think about how students will use technology to strengthen and or practice their skills. However, during the process of creating my own WebQuest, I realized how much technology could work well in the educator’s favor by thinking of a creative way of instructing, teaching, and creating an assignment. I love that WebQuest gives my students the creativity to pretend as if they are something else or enter a new world, thus, students give some excitement and encouragement in their learning, along with giving the teacher like me a new inventive way to assign tasks. For instance, the use of technology allowed me in my WebQuest to use direct links and resources, pictures, text, and videos to information needed for questions.

During the process of creating this WebQuest activity, I discover that it can facilitate and inspire student learning and creativity because it promotes innovative thinking and inventiveness. It facilitates effective use of current and emerging digital tools to locate, analyze, evaluate and use information resource to support and learning. Also, WebQuest are not just activities that utilize the internet. They are more than that. The students can experience both individual and team learning. This can be done by encouraging them to produce an authentic end product that is creative and applicable to real life. It is my responsibility to develop a WebQuest that is real, rich and relevant. I like the ideas where students work in teams, learn to cooperate and collaborate, can access the internet for information together, and most importantly apply the information in a new way (in this activity, students will create podcasts and medical care poster for the community). This leads students to use their higher thinking skills for a deeper understanding and more independent learning. As a result, they become responsible for their own learning. I also like the evaluation of Webquests with rubrics because it increases consistency of judgment when assessing their performance and authentic task. However, reliability and validity of the rubrics must be tested first before it will be used.

Bibliography

1. Dodge, B. (2001). FOCUS: Five rules for writing a great webquest. Learning and Leading with Technology, 28(8), 6-9, 58.
2. Abbit, J. & Ophus, J. (2008). What we know about the Impacts of WebQuests: A review of research. AACE Journal, 16(4), 441-456.